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Phase 2 6. OSCE > Cardiovascular examination > Flashcards

Cardiovascular examination Flashcards

1
Q

What are common symptoms of heart disease

A
  • chest discomfort
  • breathlessness
  • palpitation
  • syncope/dizziness
  • oedema
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2
Q

What are the cardiovascular causes of chest pain?

A
  • angina
  • myocardial infarction
  • pericarditis
  • aortic pain
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3
Q

Describe the characteristics of angina

A
  • precipitates by exertion

- eased by rest and/or GTN

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4
Q

Describe the characteristics of myocardial infarction

A
  • similar distribution to angina
  • more severe
  • persists at rest
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5
Q

Describe the characteristics of pericarditic pain

A
  • sharp
  • raw or stabbing
  • varies with breathing or movement
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6
Q

Describe the characteristics of aortic pain

A
  • severe
  • tearing
  • sudden onset
  • radiates to the back
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7
Q

What are the aggravating factors of angina?

A
  • exertion
  • emotional excitement
  • cold weather
  • exercise after meals
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8
Q

What are the relieving factors of angina?

A
  • rest
  • glyceryl trinitrate
  • warm-up before exercise
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9
Q

Describe the site of angina or myocardial infarction

A
  • retrosternal

- radiates to arm, epigastrum, neck

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10
Q

Describe the site of pericarditic pain

A
  • retrosternal

- may radiate down left shoulder or back

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11
Q

Describe the site of aortic pain

A

Often felt between the shoulder blades and/or behind the sternum

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12
Q

What is dyspnoea?

A
  • breathlessness
  • awareness of increased drive to breathe

(non-specific)

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13
Q

What is orthopnoea?

A

Dyspnoea on lying flat

  • sign of advanced heart failure
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14
Q

What is palpitation?

A

an unexpected awareness of the heart beating in the chest

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15
Q

In what ways can you distinguish palpitations?

A
  • onset and termination (abrupt/gradual)
  • precipitating factors (exercise/alcohol/caffeine)
  • frequency and duration
  • character and rhythm
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16
Q

What are the main causes of syncope?

A
  • postural hypotension
  • neurocardiogenic syncope (vasovagal)
  • arrythmias
  • mechanical obstruction of cardiac output
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17
Q

What are the causes of unilateral oedema of the leg?

A
  • DVT
  • soft tissue infarction
  • trauma
  • immobility
  • lymphatic obstruction
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18
Q

What are the causes of bilateral oedema of the leg?

A
  • Heart failure
  • chronic venous insufficiency
  • hypoproteinaemia
  • lymphatic obstruction
  • Drugs
  • IVC obstruction
  • Thiamine deficiency
  • Milroy’s disease
  • Immobility
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19
Q

What factors should you establish from the presenting complaint?

A
  • frequency
  • duration
  • severity
  • causative/relieving factors
  • breathessness
  • recent chest, or lower limb pain
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20
Q

How can you assess for functional impairment?

A
  • impact of symptoms
  • strenuous/gentle exercise provoking symptoms
  • can you keep up with walking with others?
  • domestic/occupational capacity
  • how far can you walk before pain (uphill/flat)
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21
Q

What factors should be obtained from the past medical history?

A
  • rheumatic fever
  • heart murmurs
  • hypertension
  • DM
  • kidney disease
  • thyrotoxicosis
  • marfan’s syndrome
22
Q

What medications should you enquire about?

A
  • thyroxine
  • amphetamines/cocaine
  • NSAIDs
  • herbal medicines
  • beta blockers
23
Q

What family history factors are relevant?

A
  • premature CAD in 1st degree

- sudden unexplained death in the family at a young age

24
Q

What social factors are important

A
  • smoking
  • alcohol
  • poor nutrition
25
Q

What should be noted on general examination?

A
  • looks unwell
  • breathless/cyanosed
  • fightened/distressed
  • medical aids (oxygen)
  • correctly position the patient at 45 degrees
26
Q

What are you looking for on the hands?

A
  • Temperature
  • peripheral cyanosis
  • CRT (<2s)
  • finger clubbing
  • splinter haemorrhages
  • tar staining
27
Q

How do you assess the radial pulse?

A
  • rate
  • rhythm
  • volume
  • character

assess simultaneously

28
Q

What are you looking for on the face?

A
  • conjuctival palor (anaemia)
  • corneal arcus (hyperlipidaemia)
  • xanthelasma (hyperlipidaemia)
  • central cyanosis (lips and tongue)
29
Q

How do you assess the jugular venous pressure

A
  • patient @ 45 degrees
  • head tilited up and to the left
  • JVP is double pulsation

Hepatojugular reflex cab exaggerate a raised JVP = press on the right upper quadrant of the abdomen

30
Q

How do you detect a collapsing pulse?

A
  • raising patients hand above their head
31
Q

What is the surface landmark for the radial pulse?

A
  • at the wrist, lateral to the flexor carpi radialis tendon
32
Q

What is a normal resting HR?

A

60-100

Bradycardia < 60
Tachycardia > 100

33
Q

What are the steps of BP measurement?

A
  • patient rested
  • support arm at heart level
  • apply cuff
  • palpate brachial pulse
  • inflate cuff until brachial pulse is impalpable
  • inflate 30 above this with stethascope over brachial artery
  • deflate slowly until you hear regular tapping (korotkoff sounds phase 1)
  • Continue to deflate until sounds disappear

sound of tapping = systolic
sounds disappear = diastolic

34
Q

What should you inspect the praecardium for?

A
  • scars
  • abnormal shape/contour
  • visible pulsations
  • devices in situ
35
Q

What should you palpate on the praecardium?

A
  • apex beat
  • heaves
  • thrills
36
Q

Where can the apex beat be found?

A
  • 5th intercostal space in the midclavicular line
  • feel the borders of the clavicle and work out 1/2 way
  • Palpate sternal angle where 2nd rib meets sternum and meet you mid point
  • Count down five spaces
37
Q

What is a heave?

A

left parasternal impulse and is resent where there is an abnormally strong cardiac impulse

38
Q

How is a heave assessed?

A

place entire stretched out hand on the chest parallel to the sternum on the left side with with your fingers pointing towards the patient’s neck

If present, heel of your hand will move

39
Q

What is a thrill?

A

palpable murmur caused by turbulent blood flow through a heart valve

40
Q

Where should a thrill be assessed?

A
  • apex
  • upper praecardium
  • sternal notch
41
Q

Which areas of the chest should be auscultated?

A
  • mitral area
  • tricuspid area
  • pulmonary area
  • aortic area
42
Q

Where is the mitral area?

A
  • 5th intercostal space in the mid-clavicular line
43
Q

Where is the tricuspid area?

A

4th intercostal space at the left sternal edge

44
Q

Where is the pulmonary area?

A

2nd intercostal sace at the left sternal edge

45
Q

Where is the aortic area?

A

2nd intercostal space at the right sternal edge

46
Q

How should auscultation be performed?

A

M > T > P > A

  • start with the diaphragm and then use the bell in the mitral area
  • palpate the carotid/radial
47
Q

What murmurs can be exaggerated?

A
  • mitral stenosis

- aortic regurgitation

48
Q

What manoeuvre can be performed on the mitral area?

A
  • ask the patient to roll onto their left hand side and listen with the bell for mitral stenosis
49
Q

What manoeuvre can be performed on the aortic area?

A
  • ask the patient to sit forward and hold their breath in expiration
  • listen at lower left sternal edge with diaphragm for aortic regurgitation
50
Q

What other areas would you mention examining?

A
  • blood pressure
  • abdominal examination
  • leg pulses
  • oedema
  • opthalmic examination
  • urine dipstick
  • observation charts
51
Q

How do you finish a cardiovascular examination?

A
  • summarize findings
  • thank patient
  • wash hands
52
Q

How do you start a cardiovascular examination?

A
  • wash hands
  • introduce yourself
  • confirm name & DOB
  • explain procedure
  • gain consent

Phase 2 6. OSCE (14 decks)

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